[Surgical treatment of secondary glaucomas with extensive goniosynechias (author's transl)]. / Traitement chirurgical des glaucomes secondaires avec goniosynéchies étendues.

The authors propose to consider that the liberation of the ciliary body of Benedikt, combined or not with vitrectomy and/or with surgery of the exposed ciliary body and/or with reconstruction of the angle and/or with the treatment of secondary glaucomas with extensive goniosynechias. 30 eyes were operated according to these principles during a period of two years. They presented an angle closure glaucoma that was neglected, provoking a chronic state via the formation of a ring shaped goniosynechia (11 eyes), an aphakic secondary glaucoma (7 eyes), neo-vascular glaucoma (3 eyes), a malignant glaucoma (3 eyes), absolute glaucoma (4 eyes), or secondary glaucoma of diverse causes (2 eyes). A favourable result in the IOP control was obtained in 69% of the cases with only a minor number of complications (ciliary body hernia (5 eyes), cataract (2 eyes), choroid hematoma (1 eye). In the future, the number of undesirable results and complications should diminish as the knowledge of the principles that guide this new surgical approach of secondary glaucomas becomes better understood.

[The reconstruction of the lacrimal pathway in the common canaliculus surgery]. / La reconstruction de la loge lacrymale dans la chirurgie du canal d'union.

We describe a new technique for restoring lacrimal pathway anatomy in common canaliculus surgery. Fourteen patients (4 men and 10 women), with a mean age of 59 +/- 19 years, suffering from chronic epiphora caused by common canaliculus stenosis were operated on (18 procedures: 14 unilateral, 4 bilateral). We used a modified Dupuy-Dutemps technique. The anterior face of the lacrimal sac was cut as a flap, which was secured with the posterior nasal mucosal flap for the posterior anastomosis plane. The common canaliculus stenosis and the external face of the lacrimal sac were excised guided by the operating microscope so as to put in place a bicanalicular device, which was left for 6 months. The anterior plane of anastomosis was made of a Goretex((R)) patch or PTFE((R)) (Polytetrafluoroethylene((R))) placed under the deep face of the orbicularis muscle. The procedure was successful in 15 of the 18 cases (success rate: 83.3%). Among the three failures, two were due to the early loss of the bicanalicular stent and one to anastomosis fibrosis. This technique made it possible to restore lacrimal pathway anatomy, which was severely modified by the dacryocystorhinostomy procedure and to protect the anastomosis from fibrosis by the surrounding tissues. Biomaterials such as Goretex((R)) and PTFE((R)) are valuable tools for this technique. In common canaliculus stenosis, restoring the lacrimal pathway with biomaterials such as Goretex((R)) or PTFE((R)) improves the functional results.

[Intracorneal suture. A simple procedure for the correction of astigmatism after cataract operation]. / La suture intracornéenne. Un procédé simple de cure d'astigmatisme après intervention de cataracte.

A simple surgical procedure to cure post cataract-surgery astigmatism is reported. Corneo-corneal (sometimes corneo-scleral), 9-0 polyamide monofilament sutures are put in radially at the end (or at the two ends) of the flattest meridian to increase its curvature and therefore its refractive power. 14 eyes were treated by this procedure, 11 of them for an "against the rule" astigmatism (1st group) and the 3 others for a "with the rule" astigmatism (2nd group). No corneal incision or resection is performed before suturing. Surgery has been efficient in all cases. As compared to a mean pre-op against the rule astigmatism of 6.55 +/- 2.20 diopters, the post-op residual astigmatism was no more than 3.16 +/- 1.94, 2.66 +/- 1.17, 2.69 +/- 1.33 and 2.80 +/- 1.74 diopters, respectively 8 days, 3 months, 6 months, 12 months after the surgery. The average axis of the effect of the surgery was almost perpendicular to the initial axis of the astigmatism. The visual acuity also improved but was dependent on other factors in addition to the refractive surgery. The results were stable from 3 months after surgery and remained unchanged in those cases where the follow-up period was 18 months or more. No significative complications have been observed and side effects have been negligible. In our opinion, the results that we have obtained open the way to the intracorneal suture, without any section of the cornea, as a potential treatment for excessive astigmatism.

[Scintigraphy of the lacrimal ducts: the value of the lateral view in the postoperative period]. / Scintigraphie des voies lacrymales: intérêt de l'incidence latérale en postopératoire.

Lacrimal scintillography, a simple, non traumatic, and physiological method, has been for a long time an useful exploration in the study of lacrimal excretory pathology. It allows an accurate diagnosis especially in the case of functional stenosis and, due to its ability to indicate the exact seat of obstruction, this technique is able to determine the surgical treatment required. This study underlines the contribution of lacrimal scintillography in the control of surgical anastomosis permeability, because of a modification in the initial technique: the use of scintillography in employing the lateral view rather than the front view, usually used, permits a better visualisation of the new surgically created excretory passage, particularly in the posterior area of nasal fossae.

[Scintigraphy of the lacrimal ducts. Value of the lateral incidence in postoperative period]. / Scintigraphie des voies lacrymales. Intérêt de l'incidence latérale en postopératoire.

Lacrimal scintillography, a simple, non traumatic, and physiological method, has been for a long time an useful exploration in the study excretory pathology. It allows an accurate diagnosis especially in the case of functional stenosis and, due to its ability to indicate the exact seat of obstruction, this technique is able to determine the surgical treatment required. This study underlines the contribution of lacrimal scintillography in the control of surgical anastomosis permeability, because of a modification in the initial technique: the use of scintillography in employing the lateral view rather than the front view, usually used, permits a better visualisation of the new surgically created excretory passage, particularly in the posterior area of nasal fossae.

[Contusion and permeability of the hemato-aqueous barrier to fluorescein. Effect of a pretreatment by local indometacine (author's transl]. / Contusion et perméabilité de la barrière hémato-aqueuse à la fluorescéine. Influence d'un pré-traitement par i'indométacine locale.

An experimental study, by angiography of the anterior segment of rabbit's eye, estimates the permeability of the hemato-aqueous barrier, using fluorescein. A trauma of the eye (contusion) leads to a rapid and significant increase in this permeability. However, local pretreatment, using an ophthalmic solution of 0,33% indometacine, almost completely stabilizes the hemato-aqueous barrier, even for elements as diffusible as fluorescein. These results suggest that application of a similar preparation to the human eye could be useful in the treatment of ocular contusions, chemical burns and angle-closure glaucoma. But the best perspective could be the application of the indometacine solution to the eye, before an operation, to reduce the sideeffects of surgery relative to the surgical break of the hemato-aqueous barrier.

[Gonioretraction using argon laser]. / La goniorétraction au laser à argon.

Argon laser trabeculoplasty (ALT) has recently become one of the most popular procedures in the treatment of chronic open angle glaucoma. Although ALT is quite efficient, its mode of action is far from understood and the rate of complications or side effects is not negligible. In 1981 we began exploring a different procedure that we have called argon laser gonioretraction (ALG) with reference to the Cairns surgical goniospasis. While the corneo-scleral trabeculum is the target for argon laser beams in ALT, in ALG the beams are directed toward the ciliary band in an attempt to get the scar to pull the scleral spur backwards and stretch the trabeculum. The procedure may also act through the uveal trabeculum. The procedure was first utilized from 1981 to 1983 in 43 chronic open angle glaucoma eyes with: 1/ a high rate of success in decreasing the intraocular pressure on a long term basis, 2/ an acceptable rate of complications. 18 months after laser surgery, intraocular pressure was fully controlled without any medical treatment in 19 cases (44%). 18 additional cases (42%) were controlled with the help of less medical treatment than before. In 4 cases (8%) the failure was complete including one case with significant prolonged and non-responsive post-op hypertension which has induced a slight alteration of the visual field. One case was lost to follow-up. Supposed advantages of ALG over ALT are: integrity of the corneo-scleral trabeculum is maintained, goniosynechiae are more peripheral, and there is less propensity to induce proliferation of endothelial cells.

[Glaucomas]. / Glaucomes.

Glaucoma is a chronic optic neuropathy related to progressive loss of visual fibers. It can lead to complete blindness. There are several types of glaucoma: primitive open angle glaucomas, angle closure glaucomas, secondary glaucomas and congenital glaucomas. The diagnosis of the disease relies on the alterations of the visual field, the measure of intraocular pressure, the aspects of the optic disc and of the iridocorneal angle. As most of the glaucomas are asymptomatic, they often induce a severe loss of vision. Therefore, its systematic screening by ophthalmologists is mandatory.

[Phacoemulsification: advantages of a consultation the day after surgery?]. / Phacoémulsification : intérêt de la visite du lendemain ?

INTRODUCTION: Cataract surgery is the most frequent surgery in France. The D1 consultation limits the extension of ambulatory care to patients who can return on their own the day after sugery. We assessed the usefulness of this systematic D1 consultation in terms of therapeutic modifications. MATERIAL AND MéTHODE: Retrospective study of patients who underwent cataract surgery in a teaching hospital from february to july 2006. The major parameter was the modification of postsurgical treatment after the D1 consultation. RESULTS: Of the 380 operated eyes studied, the patients included 145 men and 235 women, the mean age was 73.8 years (range, 43-92), 86% underwent conventional hospitalization, 70% had been operated by a senior surgeon, and 66% had no suture. At the D1 visit, 11 modifications (2.9%) were recorded: one case of athalamia, one Seidel-positive test, four cases of high IOP (>30mmHg), and five severe inflammations of the anterior segment. All the treatment changes were reported in the group of hospitalized patients, none were reported in the ambulatory patients. Of the 380 eyes studied, only one required sutures at D1, the other treatment changes were minor. CONCLUSIONS: The low output of the D1 visit raises the problem of its relevance in terms of public health. In most of the English-speaking and Scandinavian countries, patients have only one postoperative visit at 1 month. Patients could receive written and oral recommendations and a hotline number to contact the surgical team, which could allow the D1 visit to be discontinued for standard patients with uncomplicated surgery.

[Assessment of macular profile using optical coherence tomography after epiretinal membrane surgery]. / Analyse maculaire en tomographie à cohérence optique après chirurgie de membrane épirétinienne.

PURPOSE: The aim of this study was to analyze the quality and functional result of epiretinal membrane (ERM) surgery using optical coherence tomography (OCT). PATIENTS AND METHOD: We conducted a retrospective, non comparative study between January 2004 and June 2006. Thirty-two eyes were included and operated by vitrectomy for ERM. The OCT assessment of the macular profile was evaluated postoperatively on day 8, day 30 and every 3 months thereafter. The first outcome measure was postoperative abnormality of the OCT profile. The secondary outcome measure was analysis of the functional result with macular thickness and best visual acuity. The Student t-test and the paired series comparison were used for the statistical analysis. RESULTS: After surgery, 23 eyes (72%) showed abnormality of the reflectivity signal as assessed by OCT. Only nine eyes (28%) had or showed restored foveal depression and normal macular thickness. Dissociated optic nerve fiber layer appearance was observed in 43.7% (14 eyes). The best visual acuity increased from 0.58+/-0.23 LogMar to 0.25+/-0.24 after ERM surgery (p<0.001). The macular thickness decreased from 374.6+/-78.7 microm to 271+/-44.6 microm postoperatively (p<0.001). CONCLUSION: Epiretinal membrane surgery is safe and effective in terms of the functional result but most cases do not recover normal microanatomy. This feature does not influence the functional result. Mechanical traction due to peeling of the epiretinal membrane associated with peeling of the internal limiting membrane may be the cause of these microanatomical results.

[Pituitary abscess. A case report (author's transl)]. / Les abcès hypophysaires. A propos d'une observation.

The case of a patient with apparently primitive pituitary abscess is presented along with a review of the current literature on the subject. Pituitary abscess is rare and should be suspected in patients with hypopituitarism or a febrile chiasma syndrome as well as in the presence of acute or chronic relapsing aseptic meningitis. Diagnosis is based upon radiologic examination particularly tomography of the sella turcica and computerized axial tomography. With early surgical treatment the prognosis is favourable resulting at times in partial or total correction of pituitary function. Twenty-six patients were studied. In twelve of these patients no origin of the abscess was found. Pituitary tumor was found in eight patients and sphenoidal sinusitis in six patients.

[Local indomethacin and early postcontusive ocular reaction in rabbits]. / Indométhacine locale et réaction oculaire post-contusive précoce chez le lapin

The local administration of a solution of indomethacin into the conjunctival fornix of the rabbit eye before anterior segment contusion has a marked inhibition on early post-contusion hypertonia. This result strongly suggests that local indomethacin could be of value in the treatment of accidental trauma to the eye as well as in the prevention of reactions following surgical trauma.